Differences between left adrenal vein sampling sites revealed with segmental sampling in primary aldosteronism

Area of Science:

• Endocrinology
• Interventional Radiology
• Nephrology

Background:

• Primary aldosteronism diagnosis relies on adrenal venous sampling (AVS).
• Accurate lateralization of aldosterone overproduction is crucial for treatment decisions.
• Comparing left adrenal central vein (LCV) and common trunk (CMT) sampling sites is important for optimizing AVS success.

Purpose of the Study:

• To compare the efficacy of LCV and CMT sampling sites for adrenal venous sampling (AVS).
• To analyze the impact of these sampling sites on the diagnosis of primary aldosteronism subtypes.
• To evaluate the success rates and diagnostic concordance between LCV and CMT sampling.

Main Methods:

• Retrospective analysis of 432 patients undergoing cosyntropin-stimulated segmental AVS (sAVS) from 2017-2020.
• Comparison of hormone levels (aldosterone, cortisol) and selectivity index (SI) between LCV and CMT sampling.
• Subtype diagnosis based on lateralization index (LI) and sAVS, excluding cases with SI < 3.

Main Results:

• CMT sampling showed significantly lower aldosterone and cortisol levels and a higher proportion of cases with SI < 3 and < 5 compared to LCV sampling.
• Aldosterone-to-cortisol ratio and LI did not significantly differ between the two sampling sites.
• Diagnostic concordance between LCV and CMT sampling was high (94.7%), with no significant difference in concordance rates based on sAVS diagnosis.

Conclusions:

• LCV sampling more frequently meets the SI criteria for successful AVS compared to CMT sampling.
• Neither sampling site demonstrated superiority in diagnostic accuracy when criteria were met.
• LCV sampling is associated with a decreased rate of AVS failure.